| NPI | 1649534330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 20A15601) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101020098) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2019-01-28 |